| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,144 |
1,126 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,292 |
1,277 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
916 |
911 |
$16K |
| D1110 |
Prophylaxis - adult |
334 |
331 |
$14K |
| D1206 |
Topical application of fluoride varnish |
543 |
529 |
$11K |
| D0272 |
Bitewings - two radiographic images |
578 |
570 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
69 |
53 |
$5K |
| D9248 |
|
64 |
61 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
132 |
127 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
142 |
138 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
57 |
54 |
$2K |
| D1354 |
|
213 |
62 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
13 |
$748.68 |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$743.06 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$497.30 |